The Larimer County Board of
Health (BOH) convened its regular meeting at 7:00 PM at the Larimer County
Department of Health and Environment (LCDHE), 1525 Blue Spruce Drive, Fort
Collins, CO.

Members Present:
N. Mark Richards, M.D., M.P.H.

Lee Thielen, M.P. A.

Steve Yurash

C.J.
McKinney, Ph.D.

Debby Healy, RN, BHS

Executive Secretary: Adrienne LeBailly, M.D., M.P.H.

Via
conference phone

Commissioner Liaison: Steve
Johnson

Staff: Marie
Macpherson, Jerry Blehm, Paula Lady

1.
Call to order
The Board of Health meeting was called to order at
7:00 PM.

2.
Approval of October 13, 2011
meeting minutes - minutes of the October
13, 2011 meeting were unanimously approved.

Next meeting date: it
was decided that due to a conflict in schedules to meet on Thursday,
December 15th at 7:00 pm. Ms. Healy will be unable to
attend that evening. [Update Debby Healy has made
arrangements to attend the meeting] It was also decided to change
the meeting date in January from the 12th to the 19th
at 7:00 pm due to a conflict in schedules.

3.
NACCHO 2010 Profile of Local Health Departments
– Dr. LeBailly presented a PowerPoint presentation
with information from this report. The data was collected in 2010 with financial
data from 2009. This profile is done every three years. It gives us a good
snapshot of our department as well as about 2800 local public health agencies
across the United States. The survey is about 40 pages long. There was an 82%
response rate in completing this survey. 2565 local public health agencies
participated in completing the survey. Colorado’s response rate is 93% or 50
out of 54 responded to this survey. Dr. LeBailly has highlighted Larimer
County’s data with red outline on the PowerPoint slides.

Dr.
LeBailly took the group slide-by-slide through the core section of the report,
indicating how our Health Department compares to other local health departments.
Dr. Richards asked if there was an issue of particular concern. Dr. LeBailly
indicated that budgets are shrinking and public health forces all across the
country are getting smaller. The Congressional super-committee is supposed to
propose a federal budget next week or there will be across the board cuts.

Dr.
LeBailly will email a PDF copy of the NACCHO report and the PowerPoint to the
BOH members.

Mr.
Yurash inquired about the number of FTE’s in our department. He asked how the
lower number of administrative / clerical personnel impacts our department. Dr.
LeBailly clarified where some of the positions (clerical vs. paraprofessionals)
are reflected in the report. Ms. Thielen said that in public health there has
been a shift of what personnel do including more administrative / clerical
duties and in areas related to technology etc. There was some acknowledgement
that this area for the Department is barely able to get everything that is
needed done.

Policy Governance Report
for 2011- Marie took the group
through the Policy Governance Report for the Department for 2011 noting
compliance with expectations in most all areas with notations of variance
and/or special interest added into the report. This Report is similar in
format to the one completed by the County Manager and reported to the
County Commissioners.

Related
to questions from Mr. Yurash concerning the section that included a personnel
issue, Dr. LeBailly clarified for the Board that the Department follows the
County’s Human Resource Personnel policies and in this instance, the
Department’s clinical policies, as well as appropriate notification of the
Colorado Board of Nursing should an action involve a nurse.

In
the area of Customer Satisfaction, Ms. Thielen asked what the Department’s next
steps are with measures of customer satisfaction. Dr. LeBailly said that
employees were asked during the Department’s recent process to develop
performance measures in five areas one of which included specific measures of
customer service. The other measures were: inputs, outputs, outcomes and
efficiencies. The Department plans review all of the measures and develop a
prioritized list from which to implement. The next steps for this have not yet
been finalized.

In
the area of Financial Condition and Activities, Ms. Healy asked if there was a
cost associated with the accounting system changes to meet the Department’s
needs. Ms. Macpherson was hoping to utilize the one-time monies that had been
set aside in the budget hire a consultant to help with this project but has not
had the time to get the information completed to do the purchasing/hire
process. Therefore she and Bruce Peters will be working on the project
themselves to design and implement a system to put most of this information on
the County’s general ledger system.

Mr.
Yurash asked if the single audit report for 2010 was presented to the BOH. Ms.
Macpherson replied that it is a report attached (a separate document that is
referred to) to the County’s Financial report (CAFR) and has not been presented
to the BOH. Dr. LeBailly will forward an electronic version of this document
to the BOH.

Related
to the section on Fees, Dr. Richards asked if the restaurant fees are out of
line with the costs. Dr. LeBailly indicated that fees cover approximately 35%
of our costs. Ms. Macpherson indicated that personnel are the bulk of our
costs. Since staff will be getting small increases in 2012 we will see a
slight increase in costs. Fees for restaurant inspections are set by State
Statute. Dr. Richards asked if this is the only one out of line with our
costs. Ms. Macpherson replied that our Prenatal Plus program also does not
recover enough money from Medicaid to cover our costs and to her recollection
it covers about 40%.

In
the section on the Emergency Public Health Director Replacement and Back Up, Ms.
Thielen asked about the procedure of back-up in case of emergency replacement
and continuity of operations. Dr. LeBailly indicated we have a document that
spells out the delegation should there be a need. We will bring this document
to the next BOH meeting with a review. Dr. Richards asked about IT back-up.
Dr. LeBailly replied that the IT department has worked on a plan but she has
not had time to review this. In a related matter, we have submitted an
application to host an Applied Public Health Informatics Fellow for a one
year position sponsored by and paid by the CDC. We submitted this application
at no cost to the county. We should hear within the next month or so if this
will be awarded to us.

Under
Communication and Support to the Board, Dr. Richards indicated the ease of
getting in touch with Dr. LeBailly. Ms. Thielen indicated the education that is
provided to the BOH should be added to the document and that the education is
ongoing.

Mr.
McKinney commented that the governing policy language seems negative in how it
is written/presented as each statement reflects what the Public Health Director
“should not” do. He suggested that it be rewritten in a more positive light.
Ms. Macpherson indicated we would review and see where we could rewrite this
document with that in mind for next year.

Public Health Director
Evaluation Forms –
Ms. Macpherson distributed the evaluation form
that was used last year and asked board members if they would like to make
any changes for this year. Following some discussion Ms. Thielen incorporated
the following changes on the draft written form: added language related to
assessment and planning to an existing category, the order of two of the
categories was switched and it was recommended to change the scale to a 10
point scale as this broader scale would allow for a greater range of
movement. A column to write the numerical score and separate comment
section was also incorporated. Ms. Macpherson will revise the electronic
version of the form and sent it out to all BOH members. Each Board member
should complete it and e-mail it to Dr. Richards by December 8th
to compile the responses before the next BOH meeting.

Salary survey of CO
physician Public Health Directors –
Ms. Macpherson presented the County’s
recommendation’s for employee compensation
changes for 2012 (up to 2.5% increase for regular employees) and indicated
as the appointing authority for the three Division Directors (CHS
Director, EH Director and Admin Director) in the Health Department, that
Dr. LeBailly is recommending that those positions receive those same
increases as applicable as well. Salaries for all positions have not
increased in the last two years. Ms. Macpherson then distributed a copy
of a salary survey of Colorado physician Public Health Directors that was
just completed and recommended that Dr. LeBailly’s salary be considered for
at least the same % increase as the rest of the staff, as well as the officials
she appoints (2.5% increase) in 2012. Dr. Richards asked if Dr. LeBailly
receives a car allowance. Ms. Macpherson replied that she does not; she is
eligible for mileage reimbursement. Ms. Thielen indicated that this
matter seems to be out of order, that the evaluation should come before
the BOH makes a recommendation for a salary increase. It was proposed
that the salary increase recommendation along with the performance review
be presented at the next meeting.

7.
Director's Report –
Ms. Macpherson announced that Christine Bush was offered and accepted
the temporary hourly Project Manager position d for Community Health
Assessment/Public Health Improvement Planning efforts. This is an hourly
temporary position; a little under half-time through September 2012. Ms. Bush has
a bachelor’s degree from CSU in psychology and a master’s degree in public
health from John Hopkins University. She is currently a public health data
analyst with Science Applications International Corporation, working as a
consultant to the US Health Resources and Services Administration. She has a
lot of the skills and strengths we feel will be helpful to us for this project.
There are some specific expectations that must be met for this project. This
position is funded by the Colorado Department of Health and Environment with federal
pass through grant monies for $25,000. It was identified that the information about
this project needs to be sent to Board members who missed that presentation.

Dr.
LeBailly asked if the BOH would be interested in a presentation from the Health
District at the February 2012 BOH meeting on the results from the 2010
Community Survey . The Board indicated their interest and would also like to
ask that they discuss their agency’s cuts and what will things look like going
forward.

Dr.
Richards asked what next steps might be for the Syringe Exchange Program (SEP).
Dr. LeBailly recommended that this topic be moved to the January meeting. This
would give more time to get a feel for interest from law agencies and other
stakeholders. The BOH needs to make a decision on whether a formal or informal
process should take place before any decision is made to move forward with the
SEP. It was decided that next steps for the SEP be discussed at the January
BOH meeting.

Mr.
Yurash shared with the BOH a visit he had with a client going through the WIC
program.